In Cuba, various factors have led to nearly zero population growth and a rapidly aging society. In a few years, the rush of baby-boomers reaching retirement will stand the population pyramid on its head, as the country’s life expectancy already nears 80 years. Almost 20% of all Cubans live in Havana, demographically and structurally an aging city. Yet, the city is not prepared to offer its older inhabitants the spaces, services and housing options they require for a healthy quality of life. Studies must be undertaken to address this issue comprehensively, generating creative alternatives for wise use of limited resources to fulfill the material, social and spiritual needs of this growing population sector.

KEYWORDS Aging, quality of life, social environment, urban health, housing for the elderly, Cuba

INTRODUCTION The disease complex comprised of atherosclerosis, chronic kidney disease (CKD) and other associated chronic vascular diseases is the leading cause of mortality worldwide. Microalbuminuria is a marker for vascular damage in the heart, kidney and brain. This paper presents selected findings of the clinical-epidemiological Isle of Youth Study (ISYS) of markers for kidney and vascular damage from chronic vascular diseases and their common risk factors in total population, focusing on Phase 2 reassessment (in 2010) of Phase 1 (2004 to 2006) results.

OBJECTIVES (1) Update the prevalence of risk factors in the study population aged ≥20 years (adult population). (2) Confirm presence of microalbuminuria in at-risk adults diagnosed as presumptive positives in Phase I. (3) Evaluate association between microalbuminuria and selected risk factors.

METHODS Of 3779 adults positive for microalbuminuria in ISYS Phase 1, 73.1% were reevaluated. The risk-factor questionnaire was re-administered and blood pressure, weight and height were measured. Blood was tested for creatinine, glycemia, cholesterol and triglycerides. Glomerular filtration rate was calculated using the Modification of Diet in Renal Disease (MDRD) formula. Albuminuria was measured in urine using Micral-Test (Germany) and albumin/creatinine ratio (ACR) by nephelometry. This paper uses ACR as the reference for analyzing risk factor associations. Double-entry tables were developed to analyze association among microalbuminuria, risk factors and co-morbidities.

RESULTS Most prevalent risks were hypertension, consumption of nonsteroidal anti-inflammatory drugs (NSAIDs), excess weight and hypertriglyceridemia. Microalbuminuria was confirmed in 18% of cases, using the same test. Elevated prevalence of microalbuminuria was positively associated with advancing age, male sex, underweight, smoking, NSAID use, dyslipidemia, hypertension, diabetes, heart disease and stroke.

CONCLUSIONS The at-risk cohort studied presented low levels of confirmation for positive microalbuminuria. Positive microalbuminuria stratified individuals at greatest risk, except for obesity.

KEYWORDS Chronic kidney disease, cardiovascular disease, risk factors, damage markers, albuminuria, microalbuminuria, Cuba

In public health systems, priority setting in health research determines resource allocation to produce evidence and proposals aimed at solving the population’s health problems. In Cuba, the Science and Technical Division (S&T) of the Ministry of Public Health (MINSAP) leads this process, based on the country’s health policy framework and consistent with optimal use of resources. To set health research priorities (HRPs) for 2010, a three-stage interpretive method was used involving 215 professionals working at all levels of the health system in 14 territories, 22 MINSAP experts, and academic administrators and health system managers at provincial and national levels. In Stage I, HRPs were identified and confirmed in each territory using a nominal group technique and ranked using the Hanlon Method. Further classification, ranking and ratification in Stages II and III resulted in a final set of five HRPs defined in the annual Request for Proposals from which projects are selected for funding. Results reflected consensus on the need to prioritize research on determinants of low risk perception and on program management. The participatory process laid the groundwork for conducting research better designed to contribute to solutions to major health problems affecting the Cuban population.

KEYWORDS Research priorities, health services research, national health policy, Cuba

This article analyzes the entrepreneurial cooperation between Cuba and Brazil in health biotechnology. It looks at the strategies applied and the main impacts. The respective government/political wills and the corresponding South-South collaboration policies are discussed, as well as the steps taken to materialize collaboration programs, including joint production of a meningitis vaccine for Africa. This cooperation is a good example of how South-South collaboration can be a useful tool to promote capacity building and provide cost-effective health solutions for developing countries.

KEYWORDS: Biomedical technology, technology transfer, technology, pharmaceutical, international cooperation, Brazil, Cuba

INTRODUCTION: Recombinant human erythropoietin (RHuEPO) is an erythropoiesis stimulating agent (ESA) used to treat anemia in patients with total or relative erythropoietin deficit. In cancer patients, it is administered to optimize hemoglobin (Hb) levels, correct anemia and reduce the need for transfusions. Cuba produces a RHuEPO, registered in 1998 as ior®EPOCIM, that is widely used in the national public health system, mainly to treat patients with anemia due to chronic kidney disease (CKD).

OBJECTIVE: Evaluate the efficacy and safety of ior®EPOCIM in pediatric cancer patients with anemia following chemotherapy or radiotherapy. The working hypothesis posed an Hb increase ≥15 g/l in 70% of patients receiving ior®EPOCIM for 8 weeks.

METHODS: A Phase IV, multicenter, open clinical trial was conducted. Participants were 157 patients aged 1–19 years with anemia and cyto-histological diagnosis of cancer in any location. Patients received either 600 U/kg ior®EPOCIM intravenously, once weekly, or 150 U/kg ior®EPOCIM subcutaneously, 3 times a week, for 8 weeks. All patients had blood tests every week to determine hemoglobin and hematocrit, and reticulocyte and platelet counts. Mean number of transfusions required by patients during the treatment period was compared to the mean number of transfusions received in the preceding 8 weeks. Adverse events (AE) were recorded at the 4th and 8th weeks and classified by intensity and causality.

RESULTS: Hb levels rose ≥15 g/l in 68.8% of patients, and transfusion requirements decreased 17%. The most frequent adverse events were fever (19.3%), vomiting (10.2%) and flu-like syndrome (9.6%). Intensity of AE was predominantly mild. Only 7 AE were classified as very probably related to the product and none of those was severe.

CONCLUSIONS: ior®EPOCIM proved to be safe and effective at the doses and frequencies used in this patient population. As a result, this medication was recommended for use in all pediatric oncology and hematology services in the country.

Keywords: Erythropoietin, recombinant; anemia, cancer, pediatrics, medical oncology, Cuba

Introduction: Cerebrovascular disease (CVD) is the third cause of death and second cause of disability and dementia in adults aged ≥65 years worldwide. The few epidemiological studies of stroke in Latin America generally report lower prevalence and different patterns than developed countries.

Objective: Estimate the prevalence of stroke and associated risk factors in adults aged ≥65 years in Havana City and Matanzas provinces, Cuba.

Methods: Single phase, cross-sectional, door-to-door study of 3015 adults aged ≥65 years in selected municipalities of Havana City and Matanzas provinces. Variables studied were age, sex, educational level, and self-report and description of chronic disease (stroke, heart attack, angina, and diabetes mellitus), substance use (alcohol, tobacco), and dietary habits. Respondents were given a structured physical and neurological exam, and blood pressure was measured. Laboratory tests comprised complete blood count, fasting glucose, total cholesterol and fractions, triglycerides, and apolipoprotein E (APOE) genotype. Diagnosis of stroke was based on the World Health Organization’s definition. Stroke prevalence ratios (crude and adjusted), with 95% confidence intervals (CI), were calculated for the variables studied using a Poisson regression model. Risk association was analyzed using multiple logistic regression for dichotomous responses.

Results: Assessments were made of 2944 older adults (97.6% response rate). Prevalence of stroke was 7.8% (95% CI 6.9–8.8), and was higher in men. The risk profile for this population group included history of hypertension (OR 2.8; 95% CI 2.0–4.0), low HDL cholesterol (OR 2.6; 95% CI 1.7–3.9), male sex (OR 1.7; 95% CI 1.2–2.5), anemia (OR 1.6; 95% CI 1.1–2.5), history of ischemic heart disease (OR 1.5; 95% CI 1.0–2.3), carrier of one or two apolipoprotein E4 genotype (APOE ε4) alleles (OR 1.4; 95% CI 1.0–2.0), and advanced age (OR 1.3; 95% CI 1.1–1.9).

Conclusions: Stroke prevalence in this study is similar to that reported for Europe and North America, and higher than that observed in other Latin American countries. The risk profile identified includes classic risk factors plus anemia and APOE ε4 genotype.

Keywords: Apolipoprotein E4, population-based study, epidemiology, risk factors, stroke, prevalence, Cuba

Over one-third of Cuban adults live sedentary lives, accompanied by a not-surprising overweight and obesity prevalence of 43% by 2001, the year the last national survey was conducted.[1] Today, we can wager that figure is even more bloated. The associated climb in chronic disease is well-documented in our country and the world over, threatening to outstrip the resources at hand to manage such a burgeoning epidemic. In Cuba, in particular—a developing country where all are entitled to health care—population-wide weight gain forebodes a heavier chronic disease burden and an unbearable financial burden on the health system.

There are dates that weigh heavy. January 12, 2010 is one of them—not only for Haitian survivors, over one million of whom are still internally displaced, but also for the 331 Cuban health professionals who were working in the Haitian public health system when the earthquake struck. Among the first responders, these doctors, nurses, and technicians serve in Cuban health cooperation programs, which have been providing care to Haitians since 1998.[1] Once the earth settled that fateful Tuesday, they were faced with an entirely new landscape, strewn with patients in urgent need of medical care.

Soon coming to their assistance were specialists from Cuba’s Henry Reeve Emergency Medical Contingent: within 24 hours, they were on the ground equipped with medicine, materials, and expertise. Many of the arriving doctors, specially-trained in disaster medicine and epidemic prevention, were veterans of disasters in Pakistan, Indonesia, Central America and elsewhere. They relieved those who had been working around the clock since the quake, setting bones, cleaning wounds, treating burns, and shrouding the dead.

Article in press reprinted from Health Policy (2010), doi:10.1016/j.healthpol.2010.01.005 with permission from Elsevier. © Elsevier Ireland Ltd.

ABSTRACT
Cuba’s public health system is well known for its integrated first line services based on family medicine. Less publicized is the country’s experience in public hospital management. After a harsh economic crisis in the first half of the 1990s had brought the Cienfuegos hospital near to collapse, from 1996 onwards the hospital management team took advantage of the incipient economic recovery to launch an ambitious recovery process. This article reconstructs this endeavor, based on annual hospital reports, scientific publications by the hospital staff, and interviews with key decision-makers.

First the endless waiting list for elective surgery was tackled through a more efficient use of the surgery department, and an increase of ambulatory surgery. Next, overall hospital efficiency was improved in the aim to drastically reduce the average length of stay, reaching a decrease from an average stay of 12 days to a little more than 6 days in 1999. Also the emergency department was reorganized, setting up a triage system based on a color code, linked to specific emergency protocols. Attention for improving the clinical efficiency for AMI and stroke coincided with a drop in their intrahospital lethality.

Clinical guidelines for the most important diagnoses were collectively developed, adapting international evidence to the local setting. An individual and collective performance evaluation system was elaborated in a participatory way, and further evolved into a ‘total quality management’ process.

This experience of Cienfuegos hospital provides an interesting example on how a public hospital – embedded in a well developed national public health system – can be effective and efficient, even in circumstances of limited resources.

Keywords Hospital management, public health system, health services organization, strategic planning, Cuba

The global distribution of disease burden reveals alarming inequities that can only be tackled by generating the political will and organizational capacity for sustained intersectoral action (ISA) to address both health outcomes and the social determinants underlying population health indicators.

To bridge the gap often found between discourse and implementation, such action requires not only commitment and dedication of resources by leaders, central governments and the health sector itself but also empowerment of local communities—especially the poor and disenfranchised—to become a force for constructing health.

Introduction Smoking is the main preventable cause of death worldwide. The World Health Organization estimates that smoking causes 5 million deaths annually, a figure that could double shortly if the present trend in tobacco product consumption continues.

 Objectives Estimate smoking-attributable mortality in the Cuban population and provide information needed to carry out effective public health actions.

 Methods This is a descriptive study using smoking prevalence and mortality data in Cuba for 1995 and 2007. Causes of death were grouped in three categories: malignant tumors, cardiovascular diseases and chronic respiratory diseases. Etiological fractions and attributable mortality were calculated by cause and sex.

 Results Of deaths recorded in 1995 and 2007, 15% and 18% of preventable deaths were attributed to smoking, respectively. In Cuba in 2007, smoking caused 86% of deaths from lung cancer, 78% of deaths from chronic obstructive pulmonary disease, 28% of deaths from ischemic heart disease, and 26% of deaths from cerebrovascular disease.

 Conclusions Smoking is responsible for high rates of preventable mortality in Cuba. There is willingness on the part of administrative and political authorities to discourage smoking, and more than half of smokers in Cuba wish to quit smoking. Given awareness that reducing smoking is the most effective means of decreasing preventable morbidity and mortality, the country is moving steadily toward concrete, sustainable steps leading to increased life expectancy and quality of life for the Cuban population.

 Keywords Smoking, preventable mortality, preventable morbidity, Cuba

Introduction Cancer has been the second cause of death in Cuba since 1958. The National Cancer Registry (NCR) and the National Statistics Division of the Ministry of Public Health provide incidence, mortality and other relevant epidemiological data on the disease, as a basis for analysis and decision-making in public health planning for cancer control.

Objectives Describe trends in incidence and mortality of cancer in Cuba overall and by sex since 1990, and analyze the most current 3-year data for frequent types and risk of developing and dying from cancer, by age group, sex, site, and province.

Methods Cancer incidence and mortality were described using age-adjusted rates based on standard world population for 1990–2003 and 1990–2007, respectively. Crude and age-adjusted rates were calculated for the most common sites (excluding nonmelanoma skin cancer) by sex using the latest 3-year incidence data available (2001–2003) from the National Cancer Registry and mortality data (2005–2007) from the National Statistics Division of the Ministry of Public Health. To compare risk of developing and dying from cancer among Cuban provinces, age-adjusted rates were distributed in quartiles.

Results Cancer incidence and mortality have increased in both sexes since 1990. In 2001–2003, an average of 23,710 new cancer cases were diagnosed annually (excluding nonmelanoma skin cancer), and the average annual risk of developing cancer was 216.5 per 100,000 population for men and 204.0 per 100,000 population for women. Between 2005 and 2007, there were 19,671 average annual deaths from cancer in Cuba. The risk of developing and dying from cancer varies by age group and by geographic location but was highest in Havana City province. The sites with highest incidence and mortality were lung, female breast, prostate, colon, and uterine cervix.

Conclusions Cancer incidence and mortality are increasing in Cuba, and the differences by site, age, sex and geographical distribution analyzed in this article, as well as recommended further research, should serve to inform adoption and implementation of more effective strategies for the Ministry of Public Health’s national Comprehensive Cancer Control Program.

Keywords: Cancer, epidemiology, incidence, mortality, death rate, age distribution, sex distribution, registries, Cuba

Introduction Tuberculosis (TB) is a major cause of illness and death throughout the world. The World Health Organization’s Global Plan to Stop TB 2006-2015 proposes that countries cut TB mortality by half compared to 1990 rates. In Cuba, TB mortality declined steadily throughout the 20th century, particularly after 1960.

Objective Describe TB mortality distribution and trends in Cuba from January 1998 to December 2007 by infection site, sex, age and province, and determine progress towards the WHO’s 2015 target for TB mortality reduction.

Methods A time series ecological study was conducted. Death certificates stating TB as cause of death were obtained from the Ministry of Public Health’s National Statistics Division, and population data by age group, sex, and province were obtained from the National Statistics Bureau. Crude and specific death rate trends and variation were analyzed.

Results TB mortality declined from 0.4 per 100,000 population in 1998 to 0.2 (under half the 1990 rate) in 2007. Clinical forms of the disease, both pulmonary and extrapulmonary, also declined. The highest mortality rates were found in males and in the group aged ≥ 65 years. Rates were also highest in the capital, Havana, with extreme values of 0.73 and 0.39 per 100,000 population at the beginning and end of the period, respectively. Conclusions Deaths from TB declined steadily compared to total deaths and deaths caused by infectious diseases. The Global Plan to Stop TB target was met well ahead of 2015. If this trend continues, TB is likely to become an exceptional cause of death in Cuba.

Keywords Lung diseases, tuberculosis, mortality, communicable diseases, trends, Cuba

A descriptive, cross-sectional study is presented whose objective was to determine the level of knowledge about and the attitudes toward open access journals among Cuban health researchers. To this end, a printed questionnaire was distributed between March and June 2007 to a group of researchers from Cuban national health institutes, who were chosen through stratified random sampling (160 researchers from 11 institutes). Variables included level of information about Open Access Movement terms and initiatives; papers published in open access journals; and reasons to publish, or not to publish, papers in such journals. Descriptive statistics, bivariate correlations, and correspondence analysis were done using the SPSS statistical software, version 10.0 for Windows. Little knowledge of open access journals and other Open Access Movement terms and initiatives, and little use of open access journals as a publication means, were observed.

Key words: Open access journals; Cuba; research institutes; Open Access Movement